WI0100005_Complete File - Historical_20220308

0
MM NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
v r
JAMES B. HUNT JR. V
GOVERNOR
July 31, 2000
BILL HOLMAN
SECRETARY John M. Highsmith, DDS,PA
78 Nelson Street
Clyde, NC 28721
KERR T. STEVENS
DIRECTOR Dear Dr. Highsmith:
Your Status of Injection Well System Form GW-68, dated July 13, 2000, has been
received and has been reviewed. The Underground Injection Control(UIC)Group
has amended your file to reflect the change of status of your injection well.
If you at any time decide to resume using your injection well, you must submit an
injection well permit application to the Groundwater Section, UIC Group. If you
wish to permanently abandon your injection well system you must follow the
' requirements set by(Title 15A NCAC 2C O214 rules.)
If you have any further questions regarding your injection well system please contact
me at(919) 715-6166 or Amy Axon at(919) 715-6165.
a �
ti
Sincerely,
Mark Pritzl
Hydrogeological Technician II
Underground Injection Control Program
cc: CO-UIC Files
ARO-UIC Files
GROUNDWATER SECTION
1636 MAIL SERVICE CENTER, RALEIGH, NC 27699.1636 - 2728 CAPITAL, BLVD., RALEIGH, NC 27604
PHONE [phone] FAX 919-71s.0566
AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED/10% POET-CONSUMER PAPER

NORTH CAROLINA �l
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY, GROUNDWATER SECTION
STATUS OF INJECTION WELL SYSTEM
Date: July 13, 2000 Permit Number: WIDI 0000GS,—
Name: John M. Highsmith, DDS, PA
Address: 78 Nelson Street
Clyde, NC 28721
Please check the selection which most closely describes the current status of your injection well.
In addition, please provide the requested information.
1) Well is still used for injection activities.
2) _ Well is used for water supply.
3) \X Injection discontinued;
a) 4X Well temporarily abandoned b) Well permanently abandoned
Describe the method used to properly abandon the injection well. (Include a description of how the well
was sealed and the type of material used to fill the well if permanently abandoned): If you checked two
(2), report the pumping rate and what the water is used for.
E
� � �
;tionOffice
Certification: (For well abandonment)
"I hereby certify, under penalty of law, that I am personally responsible for the proper
abandonment of any injection well as required in Title 15A NCAC 2C .0214 Criteria and Standards
Applicable to Injection Wells."
(Signature)
Certification: (For information verification)
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the
information submitted in this document, and that to the best of my knowledge the information is true,
accurate, and complete."
(Signature)
G.
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��• �btS
��ow T o
�v"1 JGw Zo010
North Carolina Department of Environment and Natural Resources
Division of Water Quality-Groundwater Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERMIT NO. WI of 00
''0
lI05 DATE
NAME OF OWNER 10�+� I`( N `,�� ate-• DDS
ADDRESS OF OWNER
�Lg tet} 9LSz.
Q N
( reeU road or lot and ubdivrsion,county,town)
LOCATION OF INJECTION WELL(and source well(s), if applicable)
SAMy—
(Street/road or lot and subdivision.county,town,ijdierent than owner's address•plus description ojlocation on site)
Potential pollution source Distance from well
Potential pollution source Distance from well
Potential pollution source Distance from well
Minimum distance of well from property boundary
Quality of drainage at site 't u.a o Flooding potential of site of wooG.>/e
(good,adeyuate,poor) (high,modcrate,lon)
DRAW SKETCH OF SITE (Show property boundaries,buildings, wells,potential pollution sources.roads,approximate scale,and
north arrow.)
DESCRIBE INJECTION SYSTEM (vertical dosed loop.uncured borehole or cased water well:separate source well and
injection well;combination source and Dyection well;or other description as applicable)

INJECTION FACILITY INSPECTION REPORT -FORM B (CONTINUED)
WELL CONSTRUCTION
Date constructed /U . to 53
Drilling contractor: Name 1) I G✓cv x_a� ycw vo l ✓ ��c �y•I I
Address
Registration number I
Total depth of well Z OO Total depth of source well
(f applicable)
Inspection point Measurement Meets minimum standards Comments
Yes No
Casing
_ Depth `f 3 ✓
Diameter to�q it _i­�
Height (A.L.S.) % I .V ✓
Grout
Depth ,Z O�
Screens
Deptli(s) N I!1
Length(s)
I.D. Plate
Static water level b;j ,o nc k
Well yield
Enclosure
Enclosure floor
(concrete)
Sampling port
(labeled)
Water light pipe entry
Well enclosure entry V
Vent ✓
Functioning of heat pump system (Determine firou the owner if heat pump fiaiciions properly.)
INSPECTOR Office tie na N R g6�e 11�
WITNESS Address u)r.A-40
WITNESS Address March 1998

North Cerollna
ROUN'bWATER FIELD/LAB FORM Department of Environment Health,GROUNDWATER
and Natural Resources
11 l DIVISION OF WATER QUALITY-GROUNDWATER SECTION
County 1�'7 y?oOC� ja4 i`�~�� SAMPLE PRIORITY Lab Number_
Water ❑ Routine Dale Received Tim
Quad No U Serial No. Soli ❑ Emergency
Ou Lang. Other Rec'd by rom: Bu Courte , Hand Del.,
LatOther:
vn , on , , ❑ Chain of Custodv ll C g E:-.Iry =v: C:c.
Report To AR FRO, MRO. R,„-, P/a. ARO,
'`
WSRO,Kin., FO, Fed.Trust, Central Off., Clher: Cale Reported:
Shipped by: Bus, Courier, Hand Del.,Other- Purpose:
Colleclor(s): Dale 1'ID'OD Time lBasel' e,C plain[,��orr�pliance LUST,Pesticide Study,Federal Trust,Other.
FIELD ANALYSES Owner 1 �r� /h1
pH,� S ec. Cond.14 at 250 C Location or site
Temp. °C Odor Description of sampling point
10 Appea Sampling Method Sample Interval
rance r ore.e,c1
Field Analysis By: Remarks
LABORATORY ANALYSES
_ SOD 310 mg/l Diss.Solids 70300 moA A -Silver 46566 troll Or anochiorine Pesticides -
_ COD High 34o mg, Flcuride 951 mg( AI-Aluminum 46557 - u Organophosphorus Peslicides
COD Low 335 m ardn •Total m As-Arsenic 46551 u Nitrogen Pesticides
_ Colilorm: MF Fecal31616 /100ml Hardness noncarb 902 m Be-Barium 465M u Acid Herbicides
_ Colilorm:MF Total 3156a /I00ml Phenals 32730 uaA Et. Ca-Caldum46552 mqp PCB's
TOC 680 Specific Cond. 95 uMhos/cml Cd-Cadmium 46559 uall
Turbidity 76 NTU Sultale 945 m Cr-Chromium 46560 UoA
Residue..Suspended 530 mg/I Sullide 745 moll Cu-Copper 46562 u
Fe-Iran 46563 uo Semivolalile Organics
Oil and Grease mqJI H -Mercury 71909 ugn TPH-Diesel Range
pH 403 unit K-Potassium 46555
Alkalinily to pH 4.5 410 mgA M -Magnesium 46554 m
Alkalinity to pH 8.3 415 mgA Mft-Lead46564 —�
Manganese 46565 u
Carbonate 445 mgll NH as N 610 m 6555 m Volatile GasolOrgaine
(VOA bottle)
TPH-Gas°Ilne Ran e
Bicarbonate 44o m� TPH-BTEX Gasoline Ran e
Carbon dioxide 405 mgll NO +NO as N 63a m 64 uChloride 940 mgA P:Total as P 665 m uChromium:Hex 1032 ugA 67 u
Color:True 80 •CU
Cyanide 720 mgA
Lab Comments:
and write"DIS"in' k.
Gw-54 REV ; For Dissolved Analysis-submit filtered sample �)

- North Carolina
�l GROLINDWATER FIELD/LA6 FORA Department of Environment,Health,and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
County Ifni Uvn� SAMPLE PRIORITY Lab Number
Quad No Serial No. Water ❑Routine Dale Received Time
Soil ❑ Emergency
Lat. Long. ❑ Other Rec'd by: From:Bus ourf , Hand Del.,
Other:
❑
Reccr;To:qon
FRO, :�tRO, PRO, 4`lsr:0, 'i1i=.O, ��.�.. �r��•,--Chain of Custody � Data Enlrj E:: Ck:
WSRO, Ki , Fed. Trust, Central OII., Other: Dale Reported:
Shipped by: BtA Coulter, Hand Del., Other,
Purpose:
Colleclor(s): Date vI Time Baseli e,Co ;a�nce�LUST,Pesticide Study,Federal Trust,Other.
FIELD ANALYSES Owner lei 6�
pH4m Spec. Cond.94 at 250 C Location or site 41111 �
Temp.ro 0C Odor Description of sampling point
Appearance Sampling Method Sample Interval
Field Analysis By: Remarks °ig'"`
LABORATORY ANALYSES
_ BOD 310 m Diss.Solids 70300 mQ11 A -Silver 46566 UgA Orclanochlorine Pesticides
_ COD High 340 mgA Flour Ida 951 mco At-Aluminum 46557 uqA Organophosphorus Pesticides
COD Low 335 moll Hardn •Total 900 mall As-Arsenic 46551 ucyl Nitrogen Pesticides
Colilorm: MF Fecal 31616 /100ml Hardness lnon-catbl 902 mco Be-Barium 465M uco Add Herbicides
Colilorm: MF Total 31504 /100ml Phe of 30 u Ca-Calcium 46552 PCB's
TOC 66o m9A SpecificCd-Cadmium 4655e u
Turbidity 76 NTU Sulfate 945 Cr-Chromium 46560 uuA
Residue., Suspended530 mgA Sulfide745• moo Cu-Copper 46562 uqA
Fe-Iran 46563 ugA Semivolalile Organics
Oil and Grease mall Hg-Mercury 719M UgA TPH-Diesel Range
pH 403 unit K-Potassium 46555 mo
Alkalinity to pH 4.5 410 mgA MIL M -Ma nesium 46554 mgA
Alkalinity to pH 8.3 415 mgA tA Mn-Man anese 46565 uco
Carbonate 445 mg/I NH as N 610 mco Na-Sodium 46556 mqA Volatile Organics (VOA battle)
_ Bicarbonate 440 mall TPH-Gasoline Range
_ Carbon dioxide 405 mgA NO +NO as N 630 moll Pb-Lead 46564 uco TPH-BTEX Gasoline Range
_ Chloride 940 mg/I P:Total as P 665 mqA Se-Selenium u
Chromium:Hex t032 ug!I Zn-Zinc 46567 u
_ Color: True 60 CU
Cyanide 720 mg/I
I ' Lab Comments:
;pw-54 REV. For Dissolved Analysis-submil filtered sample and vaile"DIS"in 1 'c

North Carolina
GROUNDWATER FIELD)LAS FORIVI Department of Environment,ER QUALITY
Health,and Natural Resources
N
DIVISION OF WATER QUALITY•GROUNDWATER SECTION
I 1 County SAMPLE TYPE SAMPLE PRIORITY Lab Number 4610 LID I I
Ita'ywwo:. Jd-..' .•-`•
e ❑Water ❑Routine Date Received /-/0 2Time
Quad in Serial No. ❑ Soil ElEmergency
Lai. Long. ❑ Other / Rec'd by: sue' From:Bus,Cburier end Del.;
L/. YG Other:
Reoorl To:AnO, FRO.P.iRO,FRO,`tieFO,N1i90, ❑ Chaln of Cumodv —.I(• Qsta Entry Sy,
N/SRO,Kinston F0, Fed.Trust,Cenlrsl Oil.,Other:
L-- ------ rzuf S6porlad: /Y•.o n
Shipped by: Bus,Courier, Hand Del.,Other, Fur =a•
Colleclor(s): Date t'1c) c� Time aselin )mplaint.Compliance lBLUST,Pesticide Slud?,Fedard Trust,Clher. .e V,a
FIELD ANALYSES Owner
pH4m Spec.Cond.94 at 250 C Location or silo
jE Temp. I(- _°C Odor Description of sampling point
Appearance Sampling Method- 1 eu..rl Sample Interval
Field Analysis By: Remarks ryuro.quir motel
LABORATORY ANALYSES
_ BOD 310 mall Diss.Solids 7 / c+ MCO A -Silver 46M uW Or anochlerine Pesticides
_ COD High 340 mall Flourids 951 MCO AI-Aluminum 46557 UCO Organophosphows Pesticides
COD Low 335 mall Hardriml Total 900 1 MqA As-Arsenic 46551 ucvl Nitrogen Pesticides
AC Colilorm:MF Fecal 31616<I 1f00mI Hardness(non-=bl 902 MCO So-Barium 46558 uall Add Herbicides
Colilorm:MF Total 31504)A I100ml Phenots 32730 Urvi Ca-Calcium 46552 mqA PCB's
TOC 6e0 mo Snecific Cond.25 "Mhosicm, Cd-Cadmium 46559 UqA
Turbidity 76 NTU Sulfate 945 moll Or-Chromium 46560 ucyl
Residue.,Suspended 530 man Sulfide 745 m I I Cu-Copper 46562 u
Fe-Iron 465M UgA Semivolatile Organics
Oil and Grease m I H -Mermry 71900 u9A TPH-Diesel Range
pH 403 c unit K-Potassium 46555 mgA
Alkalinity to pH 4.5 410 mgA M -Magnesium 46554 mqA
Alkalinity to pH 8.3 415 mgA Mn-Manganese 46565 uco
Carbonate 445 m9A NH as N 610 m No-Sodium 465M m Volatile Organics(VOA bollle)
Bicarbonate 440 mall '=Nickel UaA TPH-Gasoline Range
_ Carbon dioxide 405 mgA NO NO as N 630 moll Pb-Lead 46564 uaA TPH-BTEx Gasoline Range
x Chloride 940 03 mgff P:Total as P 665 In Se-Selenium uaA
Chromium:Hex 1032 UgA Zn-Zinc 46557 u
Color:True a9 CU '
Cyanide 720 mgA H_:J
y fl0 Cc ,.k a o Ccl 'YcrM A tlr�sf'--' =11120M i1�1`,
Lab Comments: L
GW-54 REV.7r96 For Dissolved Analysis-submit filtered sample and write"DIS"in block.

North Carol Ina
GROUNDWATER FIELD/LAB FOAM Department of Environment,Health,and Natural Resources
1 DIVISION OF WATER QUALITY-GROUNDWATER SECTION
County ��+s-. vC� — +"^ "i�`"5""�` SAMPLETYPE SAMPLE PRIORITY !} L•OQO/C
Lab Number
Quad No Serial No. ❑Water El Routine Date Received Time .3 •
❑ Soil El Emergency r- -
Lat. Long. ❑ Other Reba by: From:Bus, Courie Hand Del
' Other:
R6pert To:P.F.O. FRO. MRO, RAC,WaRO.YARO, ❑ Chi o!Custody + Data Entry By: <1 CV..:
WSRO, Kinston FO, Fed.Trust,Central Off.,Other: Dale Raponed:
Shipped by: Bus,Courier,Hand Del.,Other'- Purpose:
Colleclor(s): �l�^'?+sov s Dale 1'1 O'UQ Time --elin9 Complaint,CompliancsJLLUFTy Pes:icds Study,Fedaral Trust,Ciher.
FIELD ANALYSES Owner
pH400 Spec.Cond.94 at 250 C Location or site
Temp 1 IC Odor Description of sampling point
Appearance Sampling Method Sample Interval
Field Analysis By: Remarks
LABORATORY ANALYSES
_ BOD 310 molt Diss.Solids 703W moo A -Silver 46566 u Or anochlorine Pesticides
_ COO High 340 mgA Flouride 951 mqA At-Aluminum 46557 ugA Organophosphotus Pesticides
COD Low 335 mall Hardness,Total 3moll As-Arsenic 48551 u Nitrogen Pesticides
Colilorm:MF Fecal 31616 a I If00ml Hardness(non-cartil 902 mciA Be-Barium 46558 ueA Add Herbicides
Colilorm:MF Total 31604 1100ml Phenols +o ucbl Ca-Calcium 46552 PCs's
TOC 66o mall specific Cond.95 uMhos/cm2 Cd-Cadmium 46559 ugA
Turbidity 76 NTU Sulfate 945 Moll Cr-Chromium 46660 u
Residue..Suspended 530 mgA Sulfide 745 U44 Cu-Copper 46562 uco
Fe-Iron 46563 ugA Semivclatile Organics
Oil and Grease moll H -Mercury 719M ugA TPH-Diesel Range
pH 403 unit K-Potassium 46555 in
Alkalinity to pH 4.5 410 mgA M -MarineSiUM 46554 In
Alkalinity to pH 8.3 415 mgA Mn-Man anesa 46565 ucyl
Carbonate 445 mgA NH as N 610 mcpl Na-Sodium 46556 m Volatile Organics(VOA bottle)
Bicarbonate 440 molI TPH-Gasoline Range
_ Carbon dioxide 4D5 mgA NO +NO as N 630 mall Pb-Lead 46564 uco TPH-BTEX Gasollre Range
K Chloride 94o mall P:Total as P 665 m Se-Selenium uoul
Chromium:Hex 1032 u9A Zn-Zinc 46557 u
Color:True 60 CU
Cyanide 720 mgA I
9 it' I•
Lab Comments: JAN
juyl
iL- ----
GW-54 REV.7196 For Dissolved Analysis-submit fillered sample and write"DIS"in block. ---

NOV 16 W D
DIVISION OF WATER QUALITY
Grourdwater Section
GROUNDWATER SECTION Achev_!•l° Regional Office i
November 12, 1999
U, k�
MEMORANDUM p vV�UMo
�zt3.�t�, 9ZZ;2
To: Kay Dechant
Groundwater Section
Asheville Regional Office
From: Mark Pritzl N [e-mail]
Hydrogeological Technician II
Underground Injection Control Group (UIC)
Central Office (CO)
Re: Permit# WI0100005; Request for inspection and routine sampling of John M.
Highsmith's, formally under the name of Dr. Nabors, geothermal injection well system. This
system is located at 78 Nelson Street, Clyde,NC 28721.
1. Please review the injection well permit renewal and submit any comments to the CO-UIC.
Retain the application for your UIC files.
2. Inspect the injection well site to verify that the location and construction plans submitted in
the application are accurate and the NCAC Title 15A 2C .0200 standards are being complied
with, using the enclosed Injection Facility Inspection Report(form B)as appropriate.
3. Collect samples from the influent and effluent sampling ports and submit the results to
the CO-UIC.
You are requested to return the completed Injection Facility Inspection Report(form B)to
the CO-UIC by December 15, 1999. If the inspection can not be accomplished by this date,
please inform the CO-UIC. The UIC group greatly appreciates Susie Caldwell's assistance
with this review. If you have any questions regarding this review or the UIC program,please
contact me at(919) 715-6166 or Amy Axon at(919) 715-6165.
`cc: UIC Files C�
Enclosures

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
NCDENR DIVISION OF WATER QUALITY
t ffY:A r November 12, 1999
(DAMES B HUNT JR W:
lay 4
GOVERNOR 2�
' r! John M. Highsmith, DDS
t�;�•Yir�;;,; �'��78 Nelson Street
'._`n BILL'HOLMAN `'
Clyde,NC 28721
I SECRETARY
..
f1 .qm
" ? '- C, Dear Mr. Highsmith:
q r
�F• KERR�Ti�STEVi NS�u{ -
r, o'Re` `Y ; { `' Your renewal application for a permit to use a well for the injection of
".. geothermal heat pump effluent has been received and is under review. The
Groundwater Section appreciates your timely response to our written inquiry about
i. r, the status of your geothermal heat pump system. A member of the Groundwater
Section's Asheville Regional Office staff will be contacting you to arrange an
inspection of the injection well and collect water samples as part of the review.
z ~ g
If you have any questions regarding permit or injection well rules please
-•w
-contact meat [phone] or Amy Axon at [phone].
i
Sincerely,
Mark Pritzl
Hydrogeological Technician II
r _ _
Underground Injection Control Program
L
cc: UIC Files
ARO UIC Files
GROUNOWAT[R S'CCTION
1636 MAIL SERVICE CENTER, RALEIGH, NC 27699-1636 -2728 CAPITAL. BLVD., RALEIGH, NC 276"
PHONE [phone] FAX919-71`S-0563
�� AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED/10 a PO4T-CONSVMCW PAPER

l�ZoI�0�5
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT,HEALTH,AND NATURAL RESOURCES
APPLICATION FOR PERMIT RENEWAL TO USE A WELL(S) FOR INJECTION WITH
A HEAT PUMP SYSTEM
Type 5A7 and 5QM Wells
In accordance with the provisions of NCAC Title 15A:02C.0200
complete application and mail to address on the back page.
TO: DIRECTOR,NORTFI CAROLINA DIVISION OF WATER QUALITY
DATE: 19JIL
A. SYSTEM CLASSIFICATION: Does the system re-circulate only potable water without any additives such as
corrosion inhibitors or antifreezes in continuous piping which isolates the fluid from the environment?
YES _ If yes,do not complete this form. A form GW-57 CL,(Notification Of Intent To Construct A
Closed-Loop Geothermal-Water-Only Injection Well System),should be completed.
NO If no,then continue completing this form.
B. PERMIT APPLICANT
Name: TOy/1/ //�• �/�6�r/�1��i (7s
Address: r 7 /yEL So y A P /J¢
City: ez State: /1IC p Zip code: Z21
County: fi/�fl�lT/ODrJ Telephone: & /? 7— qZ�Z
C. PROPERTY OWNER(if different fr/om/applicaant)
Name: V D
0
Address:
City: State: Zip code: o
County: Telephone: e
D. STATUS OF APPLICANT
Oc
Private: Federal: Commercial: State: Public:
V n
Native American Lands:
E. FACILITY(SITE)DATA(Fill out^ONLY if the Status/off Owner is Federal,
State,Public or ComAmerchl).
Name of Business or Facility: /�/�
Address: �, 1r�Z5291V 7� �/�,
City: �4yy� Sttate/:///&— Zip code:a�7d
County: Telephone: Contact Person:
Standard Industrial Code(s)which describe commercial facility: �1j/ST
GW-57 HPR (May 1998) Page 1 of 3

F. INJECTION PROCEDURE (specify any modifications to the injection procedure since the issuance of the
previous injection permit)
A�sED FOR 14,10 cOo�iYG OrdGy
G. WELL USE Is(are)the injection well(s)also used s the supply well(s) for either of the following?
(1) The injection operation? YES NO
(2) Your personal consumption? YES NO�-
H. CONSTRUCTION DATA
(1) Specify any and all modifications to the well casing,grout or screens since the issuance of the previous
injection permit.
(2) NC. State Regulations (15A NCAC, 2C, Section .0200) require the permittee to make provisions for
monitoring well head processes. A faucet on both influent (groundwater entering heat pump) and
effluent(water being injected into the well)lines is required. Is there a faucet on:
(a) the influent line? yesno_
(b) on the effluent line? yes_no
I. CURRENT OPERATING DATA
(1) Injection rate: Average(daily) �S gallons per minute(gpm)
(2) Injection volume: Average(daily}7Z, 00 gallons per day(gpd)
(3) Injection pressure: Average(daily) 0 pounds per square inch(psi)
(4) Injection temperature: Annual Average degrees Fahrenheit(°F)
J. INJECTION-RELATED EQUIPMENT
Attach a diagram showing any modifications to injection equipment since the issuance of the previous injection
permit including the engineering layout of the(1) injection equipment, and (2) exterior piping/tubing associated
with the injection operation. The manufacturer's brochure, if detailed,should satisfy(1).
K. LOCATION OF WELL(S)Attach a map
Include a site map (can be drawn) showing: the orientation of and distances between the injection well(s) and
any existing well(s)or waste disposal facilities such as septic tanks or drain fields located within 1000 fret of the
ground-source heat pump well system; include buildings, property lines, surface water bodies, any or3rer
potential sources of groundwater contamination. Label all features clearly and include a north arrow to indicate
orientation.
L. PERMIT LIST: Attach a list of all permits or construction approvals, received or applied for by the applicant
that are related to the site.
Examples include:
(1)Hazardous Waste Management program permits under RCRA
(2)NC Division of Water Quality Non-Discharge permits
(3)Sewage Treatment and Disposal Permits
GW-57 HPR (May 1998) Page 2 of 3

DIVISION OF NVATER QUALITY
_ Chcmistry Laboratory Report Ground Water Quality lab Number : Y00018
Dale Received : I/12/1000
COMM: ILUYYOOD SAMPLE PRIORRY Time Received : AM
QUAD Na. F]ROUDNE LJEMERGENCY Received By DS
REPORTTO : ARO Regional Office CHAIN OF CUSPODY
COLLEC30R(S) : PARSONS r EFF. Released By; DS
DATE I[10R000 11' SAMPLE TYPE Dale reported: 212MM0
TIME
PURPOSE Owner. IItGR BaIITR
Location or Site:
Description of sampling point
Sampling Method
Remarks:
LABORATORY ANALYSIS
BOD310 m /L Di..Solids 70300 en /L A Siher 46566 a /L Or anachlorim Pesticides
CODHi h340 m,/L Fluoride951 m /L X AI-Aluminum 46557 180 u /L OrganophcsphmruzPm1icides
CODLow335 m /L _ Hardness:total 900 ro /L _ As-A.46551 a /L Ni en Pesticides .,
Coliform:hlF Fecal 31616 /100ml _ Hardness: non<ar6 902 m /L Ba-Bad m46558 a /L -
C.Rf..l,fFTolal31504 /100.1 Phenol.32730 . /L X G.Celciam 46552 19 m /L Acid Herbiddes
TOC m /1 Specific Conti 95 .mhos/mil Cd-Cadium46559 u /L
Turbititv NTU Sulfate m /L X G.Chtosruum 46560 <25 a /L Semivulatiles
Residue.,Sus nded530 - m /L S.lide745 m /L X Cu-Co ra:r 1042 28 u /L TPH-Diesel Range
Total Suspended solids m /L IMBAS m /L X I Fe-Iron 1045 260 u /L
ORand Gm. m /L I He-lvlercum 71900 u /L lValatile,Organics(VOA bottle _
H units Silica m /L S K-Poiassium46555 2.3 m /L
Alkalinim to pH4.5 m /L Bomn X Mg-hia cesium 927 3.6 on /l. TPHGesoline Range
AlkAlinih•to PH8.3 m /L Formaldehvde m /L X 1,b Man enese1055 19 a /L TPH-B3EXGnsoline Range
Cartomte m /L NH3as N610 4.01 m /L X No-Sodium 929 4.8 m /L
Bewbanate na /L TKN as N625 m /L X NI-Nickel <30 a /L
Carbon dioside m /L X NO2+NOl nsn630 1.9 m /L X P6Lead 46564 <IO u /L
CMonde m /L @Total as P665 m /L Se-Selenium' u /L
Clrmmm:Hex 1032 iu u,/L PO4 m /L X Zn Z'mc 46567 14 u /L
C.Ior•.True 80 eu.
Cvmide 720 m,/L
COMMENTS:
-;ittj I tf
FEB 2 42000 '+f

DIVISION OF{VATER QUALITY
Cbemhb)Labonmu Repo"I Gmaad Wall Q.-M, Tab Number Y00017
Dale Received: I/1I/3004
COUNTY: HAYWOOD SAMPLEPRIORDY Time Received : 8;30
QUAD NO: OROUFINEEMERGENCY Received By : DS
REPORTTO ARO Regional Office CHAIN OF CUSTODY ❑
COLLECTOR(S): PARSONS I Released B7: DS
DATE 1l192QQ4 IV SAMPLETYPE Daterepwr d: MM000
MM
PURPOSE Owner. VIGIL SMIT11
lmcalionor5ile
Description of sampling point
Sampling Method:
Remarks:
LABORATORY ANALYSIS
BOD310 m /L Dos.Solids703W m /L A Sih:r4 ' a /L anocitimine Pesticides
CODHi h340 m /L Fluoride 951 m /L X AI-Alummum46557 <50 u /L Or ano hos horns Pesticides _-
COD Low335 m /L Hard.:total 900 m /L A.Arsenic 46551 u /L Nimageri Pesticides
Cold..hlF Feca131616 /100ml Hardness: noncarb1902 m /L Ba-Basium46558 u /L
Colifore:heFToU131507 /10Dm1 Phenols 32730 u /L X Ce-Celcirmt46552 11 m /L Acid Herbicides
TOC m /l Specific Cnd.95 umhos/rant Cd-Cadium46559 u /L
Turbility NTU Sulfate m /L X Cr-ammium 46%0 <25 u /L SemivolaWes
Residue.,Susremded 530 m /L Su0ide 745 m /L X Cu-Copper1042 28 a /L- Restore
ToWSwpendod solids m /L IMBAS m /L X I Fc-Imn IMS <50 u /L
Oiland Grease m /L I He-Worms,71900 u /L IVotatile Oeanics(VOA bottle
ry units Silica m /L X X-Potassium 46555 1.8 m /L
Alkalinim to H45 na /L Boren X M -Ma imn 977 3.5 ro /L TPH�asolbre Ran
Alkelimte to H83 m /L Formaldehyde m /L X Mn-Man arse 1055 <10 u /L TPH-BTFXGesolbrc Ran e
Carbonate m /L NH3 as N 610 <0.01 m /L X Na-Sodium929 4.8 m /L
Bcarbonate m /L TKN m N 6?5 m /L X Ni-Nickel <IO u /L
Cerbondioside m /L S NO2eNO3mn630 1.1 m /L X Pbd<ad46564 <10 u /L
Chloride m /L P:Tolalas P665 ME/L Selenium u /L
�rromfum:Hea1032 a /L PO4 m /L X Zn_Zinc46567 <IO u /L
Colar.True80 eu.
Cyanide 720
COMMENTS:
Frou
Oootl.is

M. OTHER MODIFICATIONS: Indicate any other modifications to the injection well system
(equipment,fluid,operation,etc.)that have occurred since the issuance of the
previous injection permit and have not been noted elsewhere on this application.
N. CERTIFICATION
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties,including the possibility of fines and imprisonment,for
submitting false information. I agree to operate, maintain, repair, and if applicable, abandon the injection well
and all related appurtenances in accordance with the approved specifications and conditions of the Permit"
(Sig lure of W Ow r or Authorized Agent)
If authorized agent is acting on behalrgf the well owner,
please supply a letter signed by the owner
authorizing the above agent.
0. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property rights in
the well(s). A well is real property and its construction on land rests ownership in the land owner in the absence
of contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner hereby consents to allow the
applicant to operate an injection well(s)as outlined in this application and that it shall be the responsibility of the
applicant to ensure that the injection well(s) conform to the Well Construction Standards (Title 15A NCAC
Subchapter 2C.0200)
(Signature of Property Owner if Different From Applicant)
Please return the completed Application package to:
Underground Injection Control Program
Groundwater Section
North Carolina DEHNR-DWQ
PO. Box 29578
Raleigh,NC 27626-0578
(Telephone: [phone])
GW-57 HPR (May 1998) Page 3 of 3

Re:uic W10100005
Subject: Re: uic W10100005
Date: Fri, 07 Jan 2000 14:35:08 -0500
From: Mark Pritzl <[e-mail]>
To: Tina Parsons <[e-mail]>
Hi,
The following parameters are needed:
pH,
metals (Cu, Cr, Fe, Mg, Mn, Ni, Pb, Zn, Ca, Al, Na and K) ,
chloride,
total dissolved solids,
hardness,
nitrate and nitrite, -�
Total Coliform and Fecal Coliform.
Remember temperature also.
Mark Pritzl
Tina Parsons wrote:
> hey mark. i didn 't get a map or construction details with this permit
> renewal (WI0100005) and i don 't have a file on it here in the office. i
> still need the parameters to be sampled also. can you fill in the gaps
> for me please. 1 am going out there monday the loth. ps. i called mr
> henning, 'cause mr. hutchinson is not taking calls (his phone is either
> always busy or the answering machine doesn 't pick up) , and they are
> supposed to get back with me, but no word yet. thanks. tina.
-Y Tina-Par-sons— Tina.-Parsons@ncmail..net —
> North Carolina Dept. of Environment and Natural Resources
> Asheville Regional Office
> Division of Water Quality - Groundwater Section
> 59 Woodfin Place
> Asheville, NC 28801
> Tel: [phone]
> Fax: [phone]
Mark Pritzl<Mark.PritzI(@ncmaiI.nct>
Hydrogeological Technician
Groundwater Section I
DENR �'�
tee,p .
(i114
Az
1�
rcl�i50
/
I of 1 �1 ✓ Ee ' 1/7/2000 3:00 PM

DIVISION OF WATER QUALITY
GROUNDWATER SECTION
January 10, 2000
MEMORANDUM
To: Tina Parsons
Groundwater Section
Asheville Regional Office
From: Mark Pritzl AP markpritz1@ncmaiLnet
Hydrogeological Technician II
UIC Group
Groundwater Section, Central Office
Re: Permit# WI0100005;
Copy of John M. Highsmith's, formally known as Dr. Daryl D.Nabors, injection well type
5A7 geothermal heat pump system files.
EJAN 12 2000
wateI Section i
Re ionai Office —

I IVQ�Ur:S
C:\PFPRO\DATA\PFINDER\UIC ,.(04f321P:.COR Statistics Ve
�.:4 •4*0-
Recs Mean Std Dev Minimum Max
Latitude 186 35%31148 .517"N 0 . 803 35%31148 .463"N 35%31
Longitude 186 82%55106 . 606"W 5 . 070 82%55106 . 87211W 82%55
Altitude 186 750 . 742 3 .701 732 . 010
No velocity records in file.
No DOP records in file.
Start ,GPS Week #796 on 04/13/95 at 22 : 01: 07
End GPS Week #796 on 04/13/95 at 22 :29 :26
Datum : WGS-84
Coordinate System : Latitude/Longitude
Altitude Mode : Height Above Ellipsoid
Altitude/Distance Units Meters
Velocity Units : Meters/Second
{
I '1
' 1 S
`4
�l�.�cvL9--c✓�� I
Iw ..ems-/cIW 6.,,-�
l

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT,HEALTH,AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR INJECTION
WITH A HEAT PUMP SYSTEM
Class 5 Wells
TO: DIRECTOR,NORTH CAROLINA DIVISION OF ENVIRONMENTAL MANAGEMENT
DATE:_5!14Q 4- 3 0 , 19 9 3
In accordance with the provisions of Article 7,Chapter 87;Article 21,Chapter 143,and regulations
Pursuant thereto,APPLICATION is hereby made for a PERMIT to construct and/or use a well or well
system as described below and in any accompanying data submitted as part of this APPLICATION.
Please type or print clearly.
A. OWNER DATA
Name' Ib)` y r 4(,o r s 1 6 I
Business: s D S
Address: e- so S v
City:
County:
OwnershiP Telephone. 20 4�/ 6 a'7-9 A 8 a
--
Federal State Private _
Public_ CP . Commercial Other(specify)
Native American Lands
B. FACILITY DATA (Fill out ONLY if the injection well(s)is(are)for the purpose of serving a
business or industry.)
Name: NC-baJs TDV1 l-,sp i o
Business:
Address: O ) Ds <-t
City: t'_I �� N _ Zip code: D R I Z
County: —[�y ylsvr-/ —
Ielephone: r/'/
C. DATING CONTRACTOR DATA
Name:
Address: /(-9
City: s h 1 I rJ = Zip code:
County:
Telephone. 7 a _ A S 3 - 6 a /
Contact Person:
D. INJECITONPR CEDURE _ (Briefly describe how th injection wells)will be used) - J� J �+
,y Q M t5 !
fr
AhV
i
GW-57 HP (June 1993) Page I of 4

Please return the completed Application package to:
UIC Program
Groundwater Section
North Carolina DEHNR-DEM
P.O. Box 29535
Raleigh,NC27626-0535
(telephone: [phone])
GW-57 HP (June 1993) Page 4 of 4

State of North Cc,Mina
Department of Envlronment,
Health and Natural Resources Ag U44jej
Division of Environmental Management
James B. Hunt, Governor [D E A , p
Jonathan B. Howes, Secretary � , V f�
A. Preston Howard,Jr., P.E., Director
April 18, 1994
Dr. Darryl D. Nabors
9 Nelson Street
Clyde, NC 28721
Dear Nabors,
In accordance with your application dated September 30, 1993,
we are forwarding Permit No. WI0100005 for the Operation and Use of
a well, for the purpose of injecting heat pump effluent, in Haywood
County.
This Permit shall be effective from the date of issuance
until April 30, 1999, and shall be subject to the conditions and
limitations stated therein.
In order to continue uninterrupted legal use of this well for
the stated purpose, you should submit an application to renew the
permit six months prior to its expiration date.
If you have any questions regarding your Permit please feel
free to contact me at (919) `733 - 3221 , ext. 407.
Sincerely,
A: Elizab& h Morey
Manager
Underground Injection Control Program
Groundwater Section
cc: UIC Files
ARO Files
Enclosures
P.O.Box 29535,Raleigh,North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50%recycled/10%post-consumer paper

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87;
Article 21 , Chapter 143, and other applicable Laws, Rules and
Regulations.
PERMISSION IS HEREBY GRANTED TO
Darryl D. Nabors
FOR THE OPERATION OF AN INJECTION WELL for the purpose of injecting
heat pump effluent. This well is located at 9 Nelson Street,
Clyde, North Carolina, in Haywood County, and will be operated in
accordance with the application dated September 30, 1993, and in
conformity with the specifications and supporting data submitted,
all of which are filed with the Department of Environment, Health,
and Natural Resources and are considered a part of this Permit.
This Permit is for Operation only, and does not waive any
provisions of the Water Use Act or any other applicable Laws, Rules
or Regulations. Operation and use of an injection well shall be in
compliance with Title 15 North Carolina Administrative Code 2C,
.0100 and . 0200 and any other Laws, Rules, and Regulations
pertaining to well construction and use.
This Permit shall be effective, unless revoked, from the date
of its issuance until April 30, 1999 and shall be subject to the
specified conditions and limitations set forth in Parts I through
VIII hereof.
Permit issued this the 18th day of April, 1994 .
Te 'L. Bush, Jr. , Assistant Chief
Groundwater Section
Division of Environmental Management
By Authority of the Environmental Management Commission.
PERMIT NO. WI0100005

PART I - GENERAL CONDITIONS
1 . The Permittee must comply with all conditions of this Permit
and with the standards and criteria specified in Criteria and
Standards Applicable to Injection Wells (15 NCAC 2C .0200) .
Any noncompliance with conditions of this Permit constitutes
a violation of the North Carolina Well Construction Act and
is grounds for enforcement action as provided for in N.C.G.S.
87-91 .
2. This Permit is effective only with respect to the nature,
volume of materials, and rate of injection described in the
application and other supporting data.
3 . This Permit is not transferable without prior notice to, and
approval by, the Director of the Division of Environmental
Management (Director) . In the event there is a desire for
the facilities to change ownership, or there is a name change
of the Permittee, a formal permit amendment request must be
submitted to the Director, including any supporting materials
as may be appropriate, at least 30 days prior to the date of
the change.
4 . The issuance of this Permit does not preclude the Permittee
from complying with any and all statutes, rules, regulations,
or ordinances which may be imposed by other local, state, and
federal agencies which have jurisdiction.
PART II - PERFORMANCE STANDARDS
1 . The injection facilities shall be effectively maintained and
operated at all times so that there is no contamination of
groundwaters which will render then unsatisfactory for normal
use. in the event that the facilities fail to perform
satisfactorily, including the creation of nuisance conditions
or failure of the injection zone to adequately assimilate the
injected fluid, the Permittee shall take immediate
corrective actions including those actions that may be
required by the Division of Environmental Management
(Division) such as the repair, modification, or abandonment
of the injection facility.
2 . The Permittee shall be required to comply with the terms and
conditions of this Permit even if compliance requires a
reduction or elimination of the permitted activity.
3 . The issuance of this Permit shall not relieve the Permittee
of the responsibility for damages to surface or groundwaters
resulting from the operation of this facility.
PAGE 2 OF 6

PART III - OPERATION AND MAINTENANCE REQUIREMENTS
1 . The injection facilities shall be properly maintained and
operated at all times.
2 . The Permittee must notify the Division and receive prior
written approval from the Director of any planned physical
alterations or additions in the permitted facility or
activity not specifically authorized by the Permit..
PART IV - INSPECTIONS
1 . Any duly authorized officer, employee, or representative of
the Division of Environmental Management may, upon
presentation of credentials, enter and inspect any property,
premises, or place on or related to the injection facility at
any reasonable time for the purpose of determining compliance
with this Permit, may inspect or copy any records that must
be maintained under the terms and conditions of this Permit,
and may obtain samples of groundwater, surface water, or
injection fluids.
2 . Department representatives shall have reasonable access for
purposes of inspection, observation, and sampling associated
with injection and any related facilities as provided for in
N.C.G.S . 87-90 . 1
3. Provisions shall be made for collecting any necessary and
appropriate samples associated with the injection facility
activities (see attached diagram) .
PART V - MONITORING AND REPORTING REQUIREMENTS
1 . Any monitoring (including groundwater, surface water, or soil
sampling) deemed necessary by the Division of Environmental
Management to insure surface and ground water protection,
will be established and an acceptable sampling reporting
schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of
the occurrence or first knowledge of the occurrence to the
Asheville Regional Office, telephone number (704)-251-6208,
of any of the following:
(A) Any occurrence at the injection facility which
results in any unusual operating circumstances;
PAGE 3 OF 6

(B) Any failure due to known or unknown reasons, that
renders the facility incapable of ,proper injection
operations, such as mechanical or electrical
failures.
3 . Where the Permittee becomes aware of an omission of any
relevant facts in a permit application, or of any incorrect
information submitted in said application or in any report to
the Director, the relevant and correct facts or information
shall be promptly submitted to the Director by the Permittee.
4 . In the event that the permitted facilities fail to perform
satisfactorily, the Permittee shall take such immediate
action as may be required by the Director.
PART VI - PERMIT RENEWAL
The Permittee shall, at least six (6) months prior to the
expiration of this Permit, request an extension.
PART VII CHANGE OF WELL STATUS
1 . The Permittee shall notify the Asheville Regional Office
within 15 days of any change of status of the injection
well(s) . Such a change would include the discontinued use of
the well(s) for injection. If the well(s) is taken
completely out of service temporarily, the Permittee must
install a sanitary seal(s) . If the well(s) is not to be used
for any purpose it must be permanently abandoned according to
15 NCAC 2C . 0113, Well Construction Standards .
2 . When operations have ceased at the facility and the well(s)
will no longer be used for any purpose, the Permittee shall
abandon the injection well(s) in, accordance with the
procedures specified in 15 NCAC 2C . 0214, including but not
limited to the following:
(A) All casing and materials may be removed prior to
initiation of abandonment procedures if the Director
finds such removal will not be responsible for, or
contribute to, the contamination of an underground
source of drinking water.
(B) The entire depth of the well(s) shall be sounded before
it is sealed to insure freedom from obstructions that
may interfere with sealing operations .
PAGE 4 OF 6

(C) The well(s) shall be thoroughly disinfected,- prior to
sealing, if the Director determines that failure to do
so could lead to the contamination of an underground
source of drinking water.
(D) The well(s) shall be completely filled with cement
grout, which shall be introduced into the well(s)
through a pipe which extends to the bottom of the
well(s) and is raised as the well(s) is filled.
(E) In the case of gravel-packed wells in which the casing
and screens have not been removed, the casing shall be
perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the
perforations.
(F) In those cases when, as a result of the injection
operations, a subsurface cavity has been created, the
well(s) shall be abandoned in such a matter that will
prevent the movement of fluids into or between
underground sources of drinking water and in accordance
with the terms and conditions of the Permit.
PART VIII - SPECIAL CONDITIONS
NONE
PERMIT NO. W10100005
PAGE 5 OF 6

AIVACHMENT 1
PERMIT NO. WI0100005
Sanitary Well Seal Sampling Tap
(Influent)
Casing must extend min. HEAT
of 12 inches above LINE PUMP
land surface
0
tr Ill Sampling Tap
<
X (Effluent)
Q 5
M
COMBINATION SOURCE
E
:3 AND INJECTION WELLro
CL
all

as .: STATE LABORATORY OF PUBLIC HEALTH
- DIVISION OF.IJEALTH SERVICES
N. C. DEPARTMENT OF HUMAN RESOURCES
r••'P,O. BOX.2 ,,,3p8 N. WILMINGTON ST., RALEIGH 27611
INORGANIC CHEMICAL ANALYSES-PRIVATE WATER SYSTEM 41 r' rrt
Complete All l6mS Abovil Hebvy Line
Ir (See Instructions'an Reverse Side) 1t
Name of . f
System
Address •) )Source of Water;
(q) Ground
ZIP 1 Surface ' ( 1 ' Both
• $ i ( ' ) Purchased
County 'Source of Sample;
/✓r�o el i 1 ` House Tap .
Report To: _ '_ "IS'y- Well Tap '
Address: ? Type of Sample;
(KI Raw
•� 1 1 Treated
Type of'Treatment:
I .),..r• +rk ("1- None I r
i( I is —•' '(' 1 Chlorlhated ( " 1 Lime
i --�Fr` ZIP" 8
{ ) Fluoridated - ( 1 Sdda Ash
Collected By; '�'� _•••': ( I Polyphosphate
„�• CE ... .. :. j It.{ .Flltere�. ...o:
) Alum 1 1 ; Water Softener I Date Colli:cted: 8 /'—, r9 " '�[M ( ( 1 Other
--�►--L_L�� Time: !3� ,
Location of Sampling Point:. Typo lif Analysis Desired:
CC. r f (�) Regular Parameters
1 Optional Parameters' I
( (5<f Bath
1 ,
Remarks: I'
Regular.Parameters
Results
Optional Parameters (List as needed)
r :
...nic - of runits,
sad . - marl Results
on <.d,p rmg/I -
enganese C O.O - I
mg/I •j
)Poor i "C eO3 mp/I
nc mg/I
Jcium : - •07 ma/I
igneslum 9• mg/I
rdness-CaCOf ICa, Mgl' a• mg/I -
calinityCaCO3 mall- '
iorlda ma/I
or mg/I _
bidity 'r ^� u
orlda N7U units '..:: --:•�(� ./
e Recelved v mg/I w,' 1 '
I ••: , Date Reported
Reported By '
t Analyzed ------------ -
• Laboratory ' ' `l
Number ' : : NUta r:,y Vut"00"A&a SIELT10
Form•1441 Rev, 10/79
vetory HEALTH DEPARTMENT
� Mildred A,.Karbaugh
Director

♦ ... .�.�e.. mar.. .. .... ..._._�_.- .. ._..-....�.... ..
WATER SAMPLE REPUR'P
HAYWOOD COUNTY HEALT�H/ DEPT. LABORATORY
WAYNESVILLE, N.C. O —ICI r 1913 -
Sanitariane .•
Name De. � N T�hs 1-92y2 c
N�sT `
REPORT: NEGATIVE FOR COLIFORM GROUP
MPN 2.21100 M.I.
chni i n
1
y
1
a
� Y

State of North Catolina
Department of Environment,
Health and Natural Resources ' •
Division of Environmental Management
r James B. Hunt, Governor H N Jonathan B. Howes,
ILes, Secretary p E IR
A. Preston Howard,Jr., P.E., Director
DIVISION OF ENVIRONMENTAL MANAGEMENT
August 25, 1993
Dr. Darryl Nabors
9 Nelson St.
Clyde, NC 28721
Dear Dr. Nabors:
Our records show that the operating permit for the water to air heat pump injection well
on your property will expire on November 1, 1993. In addition, our records do not
indicate that the well has been abandoned. In order to comply with the regulatory
requirements for permitted injection facilities (15 NCAC 2C .0211), it is imperative that
you either submit the enclosed application for permit renewal or submit the enclosed
Status of Injection Well System form that certifies the injection facility is no longer in
operation. Either form should be forwarded to us by September 30, 1993. A copy of the
original application is also enclosed for your reference.
You must make arrangements for regional office personnel to inspect your injection well
and sample effluent (injected water) to assure compliance with existing groundwater
quality regulations. You may phone your regional office at 704-251-6208. Please note
that the regulations now require that the permittee install, in a readily accessible location,
a faucet or other device suitable for collecting a sample on the effluent line (water into
well) of the injection system.
If you have any questions or need assistance, please phone me at 919-733-3221,
extension 407.
Sincerely
Kathy Grant, Manager
Underground Injection Control Program
Groundwater Section
enclosures
cc: Don Link, Asheville Regional Office
NABORS.LET
P.O. Box 29535,Raleigh,North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50%recycled/10%post-consumer paper

North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment,Health,and Natural Rescue-.-
DIVISION OF ENVIRONMENTAL MANAGEMENT-GROUNDWATER SECTION
county 0 Lab Number �� 1cl Jr
Duad No Serial No. SAMPLE PRIORITY Date Received Time
_at. Lon Rec'd b : — From:Bus, oude Hand Del.,
g ROUTINE EMERGENCY r Other: y
leportT :AR FRO, MRO, RRO, WaRO,WiRO, ❑CHAIN OF CUSTODY 1 Data Entry By: Ck:
NSRO, Kinston FO ed.Trust, Central Off., Other: Date Reported: ^'2y`1
Shipped by:Bus Courier Hand LDel.,Other, 30
purpose: �� (J
ollector(s): /�SOI pate Time /� Baseline,Complaint, ompanceLUST, Pesticide Study, Federal Trust,Other: C BLS 1+'HL ANALYSES Owner - 1 Dvaaaro
1H400 Spec.Cond.94 at 250 C Location or site
emp.10 oC Odor Description of sampling point
appearance Sampling Method Sample Interval
:ield Analysis By: Remarks tr m p,°'"°a a.=a
_ABORATORY ANALYSES pumpmp ama,aYmmp.ale)
BOD 310 m Diss.Solids 70300 mco A -Silver 46566 u Or anochlorine Pesticides
COD High 34o mgA Flouride 951 m_q4 Al-Aluminum 46557 U-0 Organophosphorus Peslici8es
COD Low 335 m Hardness;Total goo m I -As-Arsenic 46551 O u Nitrogen Pesticides
Coliform:MF Fecal 31616 /1 o0ml Hardness Inon-carb 902 mcili Be-Barium 46556 uco
Coliform:MF Total 31504 A 00ml Phenols 32730 uco Ca-Calcium 46552 a( m Acid Herbicides t
TOC 68o MIA Specific Cord. 95 uMhos(Cma Cd-Cadmium 46559 u
Turbidi 76 NTU Sulfate 945 mco Cr-Chromium 46560 u A Semivolatile Organics
Residue.,Suspended 530 mgA Sulfide 745 mqA Cu-Copper46562 u
Fe-Iron 46563 <50 u
_ H -Mercury 71900 u Volatile Organics(VOA bottle)
pH 403 unit K-Potassium 46555 m
Alkalinity to pH 4.5 410 mgA M -Magnesium 46554 ,4 7 m TPH-Gasoline Range
Alkalinity to pH 8.3 415 mgA �1J Mn-Man anese 465651/O u TPH-BTEX Gasoline Range
Carbonate 445 mgA NH as N 610 0, 04 mCVI Na-Sodium 46556 m
Bicarbonate 440 m A i-Nickel ual
Carbon dioxide 405 mgA NO +NO as N 630 0. aj mgA Pb-Lead 46564 41D ucyl
Chloride 940 mgA P:Total as P 665 mcyl Se-Selenium uco _
Chromium:Hex 1032 u Zn-Zinc 46567 3<f-O uco
Color:True eo Pt-Co
Cyanide720 mgA Ii 'r,'I 1r �1.).i
U ab Comments: 1111
'`
51994I
... .. C... rl:n..�1..�J A.-L.-:- -..L�:,(:1,-....!n.. 1 J...:,�enl Cn:�LIB-L n _J.. • 1. i__

State of North Carolina
Department of Natural Resources and Community Development
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Governor R. Paul Wilms
S. Thomas Rhodes, Secretary Director
November 16, 1988
Dr. Darryl D. Nabors
9 Nelson St.
Clyde, NC 28721
Dear Dr. Nabors:
RE: Permit 43-0076-WO-0001 for heat pump injection well in
Haywood County
In accordance with your application dated August 10, 1988
we are forwarding herewith Permit No. 43-0076-WO-0001 for the
operation and Use of a well, for the purpose ofinjecting heat
pump effluent in Haywood County.
This Permit shall be effective from the date of issuance
until November 1, 1993 and shall be subject to the conditions
and limitations stated therein.
In order to continue uninterrupted legal use of this well
for the stated purpose, you should make application for permit
renewal at least two (2) months prior to its expiration date.
Sincerely,
Roy Davis
Regional Supervisor
/tej
Attachment
cc: UIC Files
ARO Files
Pollution Prevention Pays '
P.O.Box 276R7, Raleigh, North Carolina 27611-7697 Telephone [phone]
An Equal Opportunity Affimarive Action Emplom

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION/USE OF A WELL OR WELL SYSTEM FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87;
Article 21, Chapter 143, and other applicable Laws , Rules and Regula-
tions
PERMISSION IS HEREBY GRANTED TO
Dr. Darryl D. Nabors
FOR THE OPERATION AND USE OF AN INJECTION WELL/WELL SYSTEM located
at 9 Nelson St. , Clyde, North Carolina in Haywood County, in accor-
dance with the application dated August 10, 1988 and in conformity
with the specifications and supporting data submitted, all of which
are filed with the Department of Natural Resources and Community
Development and are considered a part 'of this Permit.
This Permit is for Operation and Use only, and does not waive
any provisions or requirements of the Water Use Act or any other
applicable Laws , Rules or Regulations. Operation and use of a well
or well system shall be in compliance with Title 15 North Carolina
Administrative Code 2C, and any other Laws , Rules and Regulations
pertaining to well construction and use.
This Permit shall be effective, unless revoked, from the date of
its issuance until November, l, 1993 and shall be subject to the
specified conditions and limitations set forth in Parts I and II
hereof.
Permit issued this the PtST day of 1988 .
Roy Davis
Regional Supervisor
By Authority of the Environmental Management Commission.
PERMIT NO. 43-0076-WO-0001

PERMIT NO. 43-0076-WO-0001
PART I
A. GENERAL CONDITIONS
1 . The Permittee must comply with all conditions of
this Permit and with the standards and criteria
specified in 15 NCAC 2C . 0200 . Any Permit
non-compliance constitutes a violation of the
appropriate Act and is grounds for enforcement
action; for Permit termination, revocation and
reissuance or modification; or for denial of a
Permit renewal application.
2. It shall not be a defense for a Permittee in an
enforcement action that it would have been
necessary to halt or reduce the permitted
activity in order to maintain compliance with the
conditions of this Permit.
3. The Permittee shall take all reasonable steps to
minimize or correct any adverse impact on the
environment resulting from noncompliance with
this Permit.
4 . The Permittee shall give advance notice to the
Director of any planned changes in the permittee
facility or -activity which may result in
noncompliance with the Permit.
5 . The Permittee shall report all instances of
noncompliance, not reported under condition 1. of
this Part, at the time monitoring reports are
submitted.
6 . Where the Permittee becomes aware of a failure to
submit any relevant facts in a permit
application, or of any incorrect information
submitted in said application or in any report to
the Director, the relevant and correct facts or
information shall be promptly submitted by the
Permittee.
7 . The Permittee shall give notice to the Director
as soon as possible of any planned physical
alterations or additions to the permitted
facility. '
8 . In the event that the permitted facilities fail
to perform satisfactorily, the Permittee shall
take such immediate action as may be required by
the Director.

PART I (continued) PERMIT NO. 43-0076-WO-0001
9. The injection system shall be effectively
maintained and operated at all times so that
there is no contamination of groundwaters , or
other actions or occurrences which renders them
unsatisfactory for normal use. In the event the
facilities fail to perform satisfactorily,
including the creation of nuisance conditions,
the Permittee shall take such immediate
corrective action as may be required by the
Director.
10. Department representatives shall have reasonable
access for purposes of inspection, observation
and sampling associated with injection and
related facility.
11. This Permit is not transferable without prior
notice to, and approval by the Director.
12. An application for modification, renewal or
transfer of this Permit shall be filed with the
Department at least 30 days prior to the
expiration date of this Permit.
13. Provisions shall be made for collecting samples of
facility effluent, both prior to its entrance to
treatment devices and subsequent to leaving the
treatment devices but before entering the
injection well.
PART II
A. SPECIFIC CONDITIONS
- N O N E -

North Carolina Department of Human Resources
Division of Health Services
P.O. Box 2091 • Raleigh,North Carolina 27602-2091
James G. Martin, Governor Ronald H. Levine, M.D., M.P.H.
David T. Flaherty, Secretary November 17, 1988 State Health Director
Mr. Nathaniel C. Wilson
Permits and Compliance Group � il
Groundwater Section Jam"
Division of Environmental Management
N. C. Department of Natural Resources & Nov 21 M8
Community Development
P. 0. Box 27687
Raleigh, North Carolina 27611-7687 GROUNDWATER SECTION
RALEIGH, NC
Dear Mr. Wilson
Re: Application for an Injection
Well Permit
Dr. Darryl D. Nabors
9 Nelson Street
Clyde, North Carolina
Haycrood County
Permit No. 43-0076-WO-0001
We have reviewed the material submitted to this office concerning the
above referenced subject.
Considering the legal matter of endorsing this proposal, we believe we
do not have sufficient information to deny the request due to a threat to
the ground water source or to the public health.
Our recommendation that an assessment be made to the effects these systems
might have on groundwater remains.
If we can be of further assistance, please let us know.
Sincerely,
Linda C. Sewall, Acting Chief
Environmental Health Section
LCS/RWC/ar

OCT 7 19BR �J
NORTH CAROLINA GROUNDWATER SECTION
ENVIRROUVENTAL MANAGEMENT COMMISSION RALEIGH, NC
DEPARTMENT OF NATJRAL RESOURCES AND CUffJNITY DEVELOPMENT
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL, FOR INJECTION
CLASS 5 WELLS
TO: DIRECTOR, NORTH CAROLINA DIVISION OF ENVIRONMENTAL MANAGEMENT
DATE: 6 — I C7 , 19 b p
In accordance with the provisions of Article 7, Chapter, 87; Article
21, Chapter 143, and regulations pursuant thereto, APPLICATION is hereby
made for a PEIddIT to construct and/or use a well or well system as described
below and in any acocnpanying data submitted as a part of this APPLICATION.
A. CMER DATA: Name: �p��,�� '0 �1 �all"S
Address: �� �` j�P�Crrr� 5- --
CJrl� C ZIP: [ 7a
County: PA, kL1nr��A Telephone: , Fad9J-,
Omership Status: Federal EJ State 0 Private
Public [� Commercial
Other (Specify)
B. FACILITY DATA (Fill out ONLY if the injection wells) is (are) for
the purpose.of serving a business or industry) :
Business/Corporate Name:
Andres s:
ZIP:
County: k-�&g Telephone: 20 , %2L� .
C. HEATING CCNTRACTCR DATA (For heat pump systems only. Please give
information for the contractor that
installed or will install your system) :
Name:
Address: 64 X,7)
6L-L. ,Lu- / x) C_
ZIP: Telephone: '709f a53 .3 a/

D. INJECTION PROCEDURE:
Briefly describe how the injection well will be used,
E. WELL USE: Will the injection well also be used as the supply well(s)
for either of the following?:
(a) The injection operation? YES 0' NO ❑
(b) Your personal consunption? YES ❑ NO -
F. CONSTRUCTIM DATA: (check one)
❑ EXISTING WELL being proposed for use as an injection well. Attach a
copy of Fbnn (W-1 (Well Construction Record) and furnish (7 s 8)
below. If Form GW-1 is not available, furnish the data in (1)
through (8) below to the best of your know1 e.
❑ PEED WUL to be constructed for use as an injection well.
Furnish the data in (1) through (8) below as PROPOSED construction
specifications.
NOTE: THE WELL DRILLING COMPACTOR CAN SUPPLY THE DATA FOR EITHER
EXISTING OR PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY
OTHER A7 MS.
(1) Well Drilling Contractor's Name:
(2) Date ({ ) cnnstructed /D,/O ��3 Approx. Depth Oft.
(3) Well Casing:
(a) Type: Galvanized Steel d Black Steel ❑
Plastic ❑ Other (Specify)
�I(b) Inside Diameter: u inches; Wall thickness (inches)
or schedule #
(c) Casing Depth: From to ft. (referenced to land surface)
(4) Cement (rout:
(a) Around inner or "primary" casing: From to ft.
(b) Around outer (Pit) casing, if present: FYtan to ft.

(5) Screen(s) : (if applicable) 11I
(a) lype: Inner Diameter: inches
(b) Depth: From to feet below land surface
(6) Gravel: (if applicable)
From: to feet below land surface
(7) N.C. State Regulations (15, 2, 2C, Section .0200) require the
permittee to make provisions for monitoring well head processes. A
faucet on both the influent (pater from well) and effluent (water
into cell) lines is required. Is there.a faucet on (a) the influent
line YES NO , or (b) the effluent line yEs NO 0 ?
(8) Attach a diagram showing the details of construction of the existing
and/or proposed well(s) .
G. PROPOSED OPERATING DATA: (The manufacturer's brochure should include
this information.)
(a) Injection Rate: Average (Daily) gallons per minute (gpn)
(b) Injection Volume: Average (Daily) 60 0 gallons per day (gpd)
(c) Injection Pressure: Average (Lily) �0 pounds/square inch (psi)
.(d) Injection Temperature: Winter Average (Daily) , degrees F
Summer Average (Daily) degrees F
H. INJECTED FLUID DATA:
(1) Fluid Source (From what depth and what type of rock/sediment unit
does the fluid to be injected derive, i.e. granite,
limestone, 'sand, etc.)
Depth:
Rock/sediment unit:
(2) Chemical Analysis of Source Water: The following chemical
characteristics MUST acconpaznny tthis application;
pH 7, D ; Total Har edf� ss ppppm-(partss per million or mg/1)
Iron ppm; Chloride ppn; Nitrate
Coliform bacteria counts/100 ml
NOTE: Assistance in obtaining these values may be facilitated by
contacting (a) your local or county health official, (b) a
commercial water-testing laboratory. (c) your well drilling
contractor, or (d) the Regional Hydrogeologist, North Carolina Dept.
of Natural Resources & Community Development.
NOTE: If injection system is not for a heat pump, then a detailed
lii�ysis of both the source water and the injection fluid may be
required.

I. I JE TION-REIATED EQUIPMENT:
Attach a diagram showing the engineering layout of the (1)
injection equipment, and (2) exterior piping/tubing associated
with the injection operation.
NOTE: The manufacturer's brochure, if detailed, should satisfy (1) above
if the system is a heat pump.
J. IOCATICN OF WELL(S) :
Attach a detailed map showing the orientation of and distances
between the proposed well(s) , any existing well(s) that will in
any way be involved in the injection operation, and at least two
(2) nearby reference points such as roads, road intersections,
streams, etc. The roads should be identified by U.S., N.C. or SR
(county secondary road) numbers, and streams should be named. In
addition, the diagram should show the direction and approximate
distance to any existing water-supply and/or injection wells
within 1,000 feet of the proposed injection well.
K. CERTIFICATION:
"I hereby certify, under penalty of law, that I have personally
examined and am familiar with the information submitted in this
document and all attachments thereto and that, based on my inquiry of
those individuals immediately responsible for obtaining said
information, I believe that the information is true, accurate and
complete. I am auere that there are significant penalties, including
the possibility of fines and imprisonment, for submitting false
information. I agree to operate and use the injection well and all
related appurtenances in accordance with the approved specifications and
conditions of the Permit."
(Signature At Owner or Authorized Agent)
L. FOR OFFICE USE ONLY:
1. Initial Application: Complete Incomplete
If INCOMPLETE, Date of Notification and Resutmittal
2. Standard Industrial Code(s) which best reflect the principal products
or services provided by this facility - if applicable.
(a) (b) (c) (d)
3. APPLICATION NO.

R.__..__-.....,,,,�,.�,�.��,.� ,a'7�x�TT...�.;-. ..-+•,7�-ap•mc... . ._. . r.^—_T•:TTir'%".,..-'._.___... ... -�rs:v'c-.r.^-.... .._ ...�._,�s.ynas;•r-..
't STATE LABORATORYOF PUBLIC HEAL..t_
DIVISION OF. HEALTH SERVICES
N. C. DEPARTMENT OF HUMAN RESOURCES
r: r P.O. BOX 28047 - 306 N..WILMINGTON ST., RALEIGH 27611 .
INORGANIC CHEMICAL ANALYSES-PRIVATE WATER SYSTEM
'' •' Complete All I{emi AboVd Heavy Line '
(Set Instructions'on Reverse Side)
7 . .
Name of
SystemAr R L JJ�,s�
r ; Source of Water:
Address ("WQ Ground ( ) ' Both
( ) , Surface Purchased
�l �( Zip ZS Source of Sample:
County /✓oo '�( I House Tap '
(Sy_. Well Tap
Report To: - E Type of Sample:
Address: 44e, , n ,tj7 -D (541 Raw ( ) Treated
'- ' ' ' ' ' Type of Treatment: I"
( _ None ( ) Lime
-""" "' �.•--( ) Chlorinated ( ) 'Soda Ash
�C),A-r ALES Ui ( /.F ZIP S ( ) Fluoridated ( ) Polyphospha
ter.
; Filtered h _:,.p_
( ; ) ;. Water Softer
Collected'By: `E CE - ( ) Alum O Other
rAM ..
Date Collected: B g Time: bO Type of Analysis Desired:
"" ( V) Regular Parameters Both
Location of Sampling Point: LLY—CL r T i ( ) Optional Parameters
Remarks:
Regular Parameters Optional Parameters (List as needed)
Results
pH ' y.,y i s units i v , „�:... Results
Arsenic mg/I L
Lead c. D.tJ,3 M411 '
Iron .. C O.O S . mg/I '1
Manganese i <0e0,0 mg/I
: Copper O.O G mg/I
Zinc O. mg/I
Calcium 9, a mg/I .
MAgnesium e�. 3 mg/l
.I. Hardness-CaCO3 (Ca, M91 mg/1
Alkalinity-CaCO3 Me
Chloride S &mg/I
i
Color ! .,,'•. " u
Turbidity NTU units"...-I
Fluoride l) mg/I ,
Date Received Date Reported Reported By
Nutt 4 (JU
Date Analyzed Laboratory Number
DHS Form • 1441 Rev, 10/79 Mildred A. Kerb:
Laboratory HEALTH DEPARTMENT' Director

-
Using,typewriter or 6alcp in p
"ii' '6A, 718iormation o"A'tPP':tOP portion of form
pintfront. Please pint legibly if typewriter is riot u
available.
III
SAMPLE COLLECTION
1) Remove the one 1-quart plastic container and inflate by mouth, if uninflated.
2) Let the water (to be sampled) run for.13 minutes to assure that the water is from the distribu-
tion system.
3) Rinse the Plastic container two or thtbe times, and discard the water.
4)After rinsing, fil' the container to within approximately one inch Of top of the sampling con-
tainer. Then car--the container securely. T
.#.,SAMPLE SHIPM ENT:
1)After collection of the sample, Place;thd on 1- along
sample into the cardboard box alo I
with the report form, then seal. - . .- . .1 .
2) Mail immediately to the State Lab6ratf using the supplied label.
RECOMMENDED LIMITS FOR DRINKING WATE ARE LISTED 13ELOW:
Color 15 inits T
I I --,] Calcium No established limits
PH Not less than 6.5 units..
Magnesium No established limits
Alkalinity No established limits I Fluoride
Temperature Dependent
- Hardness, No ,-4stablishad limits i v. Arsenic 0.06 M- gli
Iron .0.30 mg/l
I il Lead 0.05 mg/i-.
Manganese 0.0i'virri
1."1...1. 1 Zinc 5.00 mg/I
Turbidity 5 ur.its Copper 1.00 mg/I
Chloride 250 'ng/I
FOR LABORATORY USE'ONLY
i. 14 1:
L)Lit i
A11141 I I I A .

WATER SAMPLE REPORT
HAYWOOD COUNTY HEALTH DEPT. LABORATORY '
WAYNESVILLE, N.C.
Sanitarian@
Namej:Af.r Np41 _
REPORT: NEGATIVE FOR COLIFORM GROUP
MPN -2.2 f 100 mi.
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Pum,• installer Address Reg. 4
Name
Heets'-►iin.-'Standards -
easure Yes No Remarks
} #,
rA� 1 1h( ,
Enclosure —+� �
Enclosure floor
Casing height
Access Dort - .- - -.,_/Z /- � •- �� '
Valved flow -
water tight oioe entry ........'- -•-_ , ..- _ - - . ..__ _.
Vent y:
Hose bib,
L.
curtiCO line ,. _ _- ---
Chlorinatioe-
Pate He11=Coaatructed 'Y 7
Date Pumv Installed • 44 -
. . .. gignature
_ Witness.- _ _.-_. ... . .
... _ Type-,
_.:._:dress
Name
Nam
- Address Type
a
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,
DIVISION OF ENVIRONMENIAL MANAGEMENT
ASHEVILLE REGIONAL OFFICE
GROUNDWATER SECTION
September 16, 1988
MEMORANDUM
TO: Nat Wilson
Permits and Compliance Unit, Raleigh l
THROUGH: Don Link, Hydrogeological Regional Supervisor 1�4-
/ d� ,
FROM: Diane Eskenasy, Hydrogeological Technician f�•c' a '% ;c'..
SUBJECT: UIC Permit Applications and Well Inspections
I have attached Mr. Buckner's latest application which had been mailed
to this office. His well has been sampled and reinspected as of September
13, 1988. After lightening struck his well last month, the effluent line
was redirected toward a buried water storage tank. that serves to water the
lawn. All overflow is introduced to the woods at present, but Mr. Buckner
would like to maintain the option of injecting the effluent. The effluent
was sampled from the mouth of the discharge pipe at the edge of the woods.
Mr. Bramley's well has been inspected; a copy of the inspection report
is also attached. Per your instructions, I did not resample that well.
Mr. Henning's well was inaccessible at this time. The well has been
surrounded by a decorative well house, and we were not able to remove the
lid. He has given me the name of his maintenance man who should be able to
assist me in obtaining samples.
I have not yet received the application for Dr. Darryl Nabors' well in
Haywood County. The office manager from his office told me they were in
the process of installing the hose bibbs.
DE:ar
Attachments
FO
RISCP 198,
GROUNDWATER SECTION
RALEIGH, NC

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION/USE OF A WELL OR WELL SYSTEM FOR' INJECTION
In accordance with the provisions of Article 7, Chapter 87;
Article 21, Chapter 143, and other applicable Laws , Rules and Regula-
tions
.PERMISSION IS HEREBY GRANTED TO
Dr. Darryl D. Nabors
FOR THE OPERATION AND USE OF AN INJECTION WELL/WELL SYSTEM located
at 9 Nelson St. , Clyde, North Carolina in Haywood County, in accor-
dance with the application dated August 10, 1988 and in conformity
with the specifications and supporting data submitted, all of which
are filed with the Department of Natural Resources and Community
Development and are considered a part of this Permit.
This Permit is for Operation and Use only, and does not waive
any provisions or requirements of the Plater Use Act or any other
applicable Laws , Rules or Regulations. Operation and use of a well
or well system shall be in compliance with Title 15 North Carolina
Administrative Code 2C, and any other Laws , Rules and Regulations
pertaining to well construction and use.
This Permit shall be effective, unless revoked, from the date of
its issuance until November 1, 1993 and shall be subject to the
specified conditions and limitations set forth in Parts I and II
hereof.
Permit issued this the day of 1988 .
Roy Davis
Regional Supervisor
By Authority of the Environmental Management Commission.
PERMIT NO. 43-0076-WO-0001

PERMIT NO. 43-0076-WO-0001
PART I
A. GENERAL CONDITIONS
1 . The Permittee must comply with all conditions of
this Permit and with the standards and criteria
specified in 15 NCAC 2C . 0200 . Any Permit
non-compliance constitutes a violation of the
appropriate Act and is grounds for enforcement
action; for Permit termination, revocation and
reissuance or modification; or for denial of a
Permit renewal application.
2 . It shall not be a defense for a Permittee in an
enforcement action that it would have been
necessary to halt or reduce the permitted
activity in order to maintain compliance with the
conditions of this Permit.
3 . The Permittee shall take all reasonable steps to
minimize or correct any adverse -impact on the
environment resulting from noncompliance with
this Permit.
4 . The Permittee shall give advance notice to the
Director of any planned- changes in the permittee
facility. or activity which may result in
noncompliance with the Permit.
5 . The Permittee shall report all instances of
noncompliance, not reported under condition 1. of
this Part, at the time monitoring reports are
submitted.
6 . Where the Permittee becomes aware of a failure to
submit any relevant facts in a permit
application, or of any incorrect information
submitted in said application or in any report to
the Director, the relevant and correct facts or
information shall be promptly submitted by the
Permittee.
7 . The Permittee shall give notice to the Director
as soon as possible of any planned physical
alterations or additions to the permitted
facility .
S . In the event that the permitted facilities fail
to perform satisfactorily, the Permittee shall
take such immediate action as may be required by
the Director.

PART I (continued) PERMIT NO. 43-0076-WO-0001
9 . The injection system shall be effectively
maintained and operated at all times so that
there is no contamination of groundwaters , or
other actions or occurrences which renders them
unsatisfactory for normal use. In the event the
facilities fail to perform satisfactorily,
including the creation of nuisance conditions,
the Permittee shall take such immediate
corrective action as may be' required by the
Director.
10. Department representatives shall have reasonable
access for purposes of inspection, observation
and sampling associated with injection and
related facility.
11 . This Permit is not transferable without prior
notice to, and approval by the Director.
12. An application for modification, renewal or
transfer of this Permit shall be filed with the
Department at least 30 days prior to the
expiration date of this Permit.
13 . Provisions shall be made for collecting samples of-
facility effluent, both prior to its entrance to -
treatment devices and subsequent to leaving the
treatment devices but before entering the
injection well.
PART II
A. SPECIFIC CONDITIONS
N O N E -

. _ ea•ergo
State of North Carolina
Department of Natural Resources and Community Development
Asheville Regional Office
James G. Martin, Governor David R. Spain
S. Thomas Rhodes, Secretary Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
GROUNDWATER SECTION
July 12, 1988
Diane Mehaley, Office Manager
Darryl D. Nabors, DDS, PA
P. 0. Box 869 Lf 2 ( �5-• s � ;i ',;
Clyde, North Carolina 28721 i6 a
Subject: Injection Well Permit Application JUL 14
Dr. Darryl Nabors' Office
Haywood County, North Carolina GROUNDWATER SECTION
Dear Ms. Mehaley:
RALEIGH, NC
In reference to our telephone conversation on June 23 , 1988, I have
enclosed a new permit application, a copy of the regulations (North
Carolina Administrative Code, Title 15, Well Construction Standards,
Criteria and Standards applicable to Injection Bells) pertaining to the
injection 'system at Dr. Nabors' office, and a copy of my February 11, 1987,
letter to Dr. Nabors regarding regulations and permit procedures.
Samples of the source water shall be taken from the influent spigot .at
the well head for pH, total hardness, iron, chloride, nitrate, and coliform
bacteria, and results submitted as a part of the permit application as soon
as possible.
Please send your completed permit application to Nat Wilson, North
Carolina Department of Natural Resources and Community Development,
Division of Environmental Management, Groundwater Section, P. 0. Box 27687,
Raleigh, North Carolina 27611. When the application has been issued, I
will contact you so that I may sample both the influent and effluent lines.
If you have any questions, please call me at 704-251-6208, ext. 267,
or contact Nat Wilson at 919-733-3221.
Sincerely,
Diane M. A. Eskenasy, P. G.
Hydrogeological Technician
DMAE:ar
Enclosures
cc: drat Wilson
Interchange Building, 59 Woodfin Place, P.O. Box 370, Asheville, N.C. 28802-0370 •Telephone [phone]
An Equal Opportunity Affirmative Action Employer